Actemra

Indicated For

Rheumatoid Arthritis, Giant Cell Arteritis, Systemic Juvenile Idiopathic Arthritis, Polyarticular Juvenile Idiopathic Arthritis, Macrophage Activation Syndrome

About This Medication

# Genentech Patient Foundation Patient Guide: How to Get Actemra (tocilizumab) at Low or No Cost Actemra (tocilizumab) is a prescription medication used to treat certain inflammatory conditions like rheumatoid arthritis, giant cell arteritis, and cytokine release syndrome. The **Genentech Patient Foundation** helps eligible patients get **Actemra** for free if they lack insurance coverage for the medicine or face financial hardship.[1][2][5] ## About Actemra (tocilizumab) **Actemra** is an injectable biologic drug that works by blocking interleukin-6 (IL-6), a protein involved in inflammation. It's FDA-approved for adults and children with moderate to severe rheumatoid arthritis (RA) who haven't responded well to other treatments like TNF blockers. It can be given by intravenous (IV) infusion every 4 weeks or as a subcutaneous injection every 1-2 weeks, depending on the condition. Common side effects include upper respiratory infections, headache, high blood pressure, and injection site reactions. Serious risks include infections, liver problems, and gastrointestinal perforations—always discuss with your doctor.[5][7] This guide focuses on the **Genentech Patient Foundation**, which provides free Actemra to qualifying U.S. patients treated by U.S.-licensed physicians. No citizenship or immigration info is required.[1][5] ## Who Qualifies? Eligibility depends on your insurance status and finances. There are three main groups:[5][9] 1. **Uninsured patients** (no health insurance) with household income under $150,000 (some exceptions apply).[5] 2. **Insured patients** whose plan covers Genentech medicines but have an **out-of-pocket maximum** over 7.5% of yearly income, and household size/income meets criteria.[5] 3. **Underinsured patients** with financial concerns who can't afford cost-sharing (e.g., high copays, deductibles).[1][5] **Key notes:** Insured patients should first pursue other assistance options. Those in Accumulator/Maximizer plans or required to use AFP vendors may not qualify. Medicare, Medicaid, or other public/private plans are considered case-by-case.[4][5][7] ## Income Eligibility Breakdown Specific Federal Poverty Level (FPL) percentages aren't publicly detailed, but income is verified against household size. Uninsured typically need income < $150,000. Insured focus on out-of-pocket costs relative to income.[5] | Household Size | Uninsured Max Income (approx.) | Insured Criteria | |---------------|-------------------------------|------------------| | 1 | Under $150,000* | OOP max >7.5% of income[5] | | 2 | Under $150,000* | OOP max >7.5% of income[5] | | 3 | Under $150,000* | OOP max >7.5% of income[5] | | 4 | Under $150,000* | OOP max >7.5% of income[5] | | 5+ | Call for details (888) 941-3331 | OOP max >7.5% of income[5] | *Household income includes AGI; exceptions may apply. Use the online Confirm Financial Eligibility tool or call for exact qualification.[5][9] ## Insurance Requirements - **Uninsured:** Primary group; easiest eligibility if income qualifies.[1][5] - **Commercially insured:** Eligible if no coverage for Actemra or unaffordable costs (e.g., deductible/OOP >7.5% income).[5] - **Medicare/Medicaid:** May qualify if no coverage for the medicine or financial hardship; proof of denial/appeal not required but appeals can run parallel.[4][5][7] - **Ineligible:** Plans requiring AFP vendors, Accumulators, or Maximizers for new patients.[4] Exhaust other options first if insured. Foundation Specialists can guide you.[2] ## Step-by-Step Application Process Applications are free and processed quickly. **Both forms required:** Patient Consent Form (English/Spanish) and Prescriber Foundation Form.[1][5] 1. **Check eligibility:** Use gene.com/patients/patient-foundation/see-if-you-qualify or call (888) 941-3331 (Mon-Fri, 6am-5pm PT).[9][2] 2. **Complete Patient Consent Form:** Fill online at gene.com/patients/enrollment. Provide household size, income (AGI), DOB, ZIP. Sign Boxes 1-2.[1][6] 3. **Doctor completes Prescriber Foundation Form:** Includes treatment info, diagnosis, eligibility confirmation. Available at GenentechPatientFoundation.com.[1][5] 4. **Submit together:** - **Online:** eSubmit or My Patient Solutions (for HCP).[1][3] - **Text photo:** 650-877-1111[1] - **Fax:** 833-999-4363[1][2] - **Phone help:** (888) 941-3331[2] 5. **Wait for review:** Processed in ~5 business days. You'll be contacted with outcome.[1][8] No extra docs like proof of income/appeal needed initially—delays if submitted.[4] ## Timeline and Delivery - **Processing:** 5 business days after both forms received.[1] - **Approval notice:** Patient and doctor contacted by phone/email.[1][5] - **Delivery:** Free Actemra shipped to your home or doctor's office for up to 1 year (if approved).[5][7] - **Reauthorization:** Annual reverification required; enrolled patients continue if still eligible.[4][7] ## Alternatives if Denied - **Call Foundation Specialist** (888) 941-3331 for local resources or other Genentech programs like co-pay assistance (if insured).[2][4] - **Appeal insurance denial** simultaneously—no proof needed for Foundation app.[4] - **State programs/PAPs:** Check needymeds.org or 211.org. - **Genentech Access Solutions:** Broader support at gene.com/patients.[3] - **No biosimilars** listed for Actemra currently.[Provided data] ## Disclaimer This guide is for informational purposes based on Genentech Patient Foundation details as of latest available info. Eligibility can change; always verify with (888) 941-3331 or gene.com/patients/patient-foundation. Not medical/financial advice—consult your doctor and advisor. Genentech not liable for errors. Program for U.S. residents only. Word count: 1028.

Program information last verified: March 30, 2026